|
STEM ACCOLADE II SZ 9 132 DEG
|
Facility
|
IP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 9 132 DEG
|
Facility
|
OP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem Medicaid |
$4,851.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Humana KY Medicaid |
$4,851.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,900.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,948.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACTIS DUOFIX 12/14 TPR SZ
|
Facility
|
OP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem Medicaid |
$4,169.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Humana KY Medicaid |
$4,169.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,212.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,253.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
STEM ACTIS DUOFIX 12/14 TPR SZ
|
Facility
|
IP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
STEM APEX HUMERAL 10 MINI
|
Facility
|
IP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
STEM APEX HUMERAL 10 MINI
|
Facility
|
OP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem Medicaid |
$7,103.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Humana KY Medicaid |
$7,103.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,175.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,246.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
STEM APEX HUMERAL 11 MINI
|
Facility
|
OP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem Medicaid |
$4,821.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Humana KY Medicaid |
$4,821.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,870.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,918.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 11 MINI
|
Facility
|
IP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 12 MINI
|
Facility
|
OP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem Medicaid |
$4,821.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Humana KY Medicaid |
$4,821.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,870.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,918.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 12 MINI
|
Facility
|
IP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 13 MINI
|
Facility
|
IP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 13 MINI
|
Facility
|
OP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem Medicaid |
$4,821.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Humana KY Medicaid |
$4,821.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,870.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,918.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 14 MINI
|
Facility
|
IP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 14 MINI
|
Facility
|
OP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem Medicaid |
$4,821.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Humana KY Medicaid |
$4,821.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,870.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,918.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 15 MINI
|
Facility
|
OP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem Medicaid |
$4,821.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Humana KY Medicaid |
$4,821.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,870.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,918.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 15 MINI
|
Facility
|
IP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 5 MINI
|
Facility
|
IP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 5 MINI
|
Facility
|
OP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem Medicaid |
$4,821.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Humana KY Medicaid |
$4,821.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,870.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,918.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 6 MINI
|
Facility
|
OP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem Medicaid |
$4,821.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Humana KY Medicaid |
$4,821.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,870.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,918.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 6 MINI
|
Facility
|
IP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 7 MINI
|
Facility
|
IP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 7 MINI
|
Facility
|
OP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem Medicaid |
$4,821.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Humana KY Medicaid |
$4,821.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,870.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,918.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 8 MINI
|
Facility
|
OP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem Medicaid |
$4,821.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Humana KY Medicaid |
$4,821.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,870.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,918.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 8 MINI
|
Facility
|
IP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 9 MINI
|
Facility
|
IP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
